Laryngectomy Definition

Definition

Laryngectomy is a surgical procedure for the partial or complete removal of the larynx, usually applied as a treatment for cancer of the larynx.

Purpose

A laryngectomy is normally used to remove tumors or cancerous tissue. In some rare cases, it may also be performed when the patient’s larynx has been severely damaged by gun or car accident injuries, or other similar violent accidents. Laryngectomies can be either total or partial. Total laryngectomies are done when cancer is advanced. In this case, the entire larynx is removed. Often, if the cancer has spread further, other structures in the neck area, such as lymph nodes, can also be removed. Partial laryngectomies are usually applied when cancer is located in a single spot. Laryngectomies are also performed when all other cancer treatments, such as radiation or chemotherapy, have failed to provide the required results.

Precautions

Only after cancer of the larynx has been diagnosed after a series of tests that allow the ENT doctor (a specialist often called an ear, nose, and throat doctor) to examine the throat and take tissue samples (biopsies) to confirm and stage the cancer, that laryngectomy is done. The patient must be in good general health to undergo a laryngectomy, and will undergo standard preoperative blood tests to make sure that they are able to safely sustain the operation.

Description of the procedure

The larynx is located just below the place where the throat splits into the esophagus, which takes food to the stomach, and the trachea, which leads the air to the lungs. The larynx plays a crucial role in the process of normal breathing, swallowing food, and speaking. Within the larynx, the vocal folds can be found (often referred to as vocal cords), which vibrate as air is exhaled past them, thus creating voice. The epiglottis protects the trachea, making sure that only air gets into the lungs. When the larynx is removed, these functions are lost.

After the larynx is removed, air can no longer flow into the lungs. During this surgical procedure, the larynx is removed through an incision in the neck. The surgeon also performs a tracheotomy, where he makes an artificial opening called a stoma in the front of the neck. The upper portion of the trachea is brought to the stoma and secured, making a permanent alternate way for air to get to the lungs. The connection between the throat and the esophagus is not normally affected, so after healing, the person whose larynx has been removed (called a laryngectomee) can eat normally. However, normal speech is no longer possible. Several alternate means of vocal communication can be learned with the help of a speech pathologist.

Preparation

As with any surgical procedure, the patient will be required to sign a consent form after the procedure is thoroughly explained. Many patients prefer a second opinion, and some insurers require it. Blood and urine studies, along with chest x ray and EKG may be ordered as the doctor deems necessary. The patient also has a pre-operative meeting with an anesthesiologist. If a complete laryngectomy is planned, it may be helpful to meet with a speech pathologist and/or an established laryngectomee for discussion of post-operative expectations and support.

Aftercare

Laryngectomees usually spend several days in an intensive care and receive intravenous fluids and medication. Blood pressure, pulse, and respirations are monitored regularly. The patient is encouraged to turn, cough, and deep breathe to help move secretions around the lungs. One or more drains are usually inserted in the neck to remove any fluids that collect. These drains are removed after several days.

In a normal case, it takes usually two to three weeks for the tissues of the throat to heal sufficiently. During this period, the laryngectomee cannot swallow food and must receive nutrition through a tube inserted through the nose and down the throat into the stomach. While this period lasts, even people with partial laryngectomies are unable to produce speech.

When air is inhaled normally through the nose, it is warmed and moistened before it reaches the lungs. When air is inhaled through the stoma, it is impossible to be warmed and humidified in the normal manner. In order to keep the stoma from drying out and becoming crusty, laryngectomees are encouraged to breathe artificially humidified air. The stoma is usually covered with a light cloth or a latex cover to keep it clean and to keep unwanted particles from accidentally penetrating the lungs. Care of the stoma is extremely important, since it is the person's only way to get air to the lungs. After a laryngectomy, a healthcare professional will teach the laryngectomee and his or her caregivers how to care for the stoma.

Immediately after a laryngectomy, an alternate method of communication such as writing notes, gesturing, or pointing must be used. A partial laryngectomy patient will gradually regain some speech several weeks after the operation, but the voice may be hoarse, weak, and strained. A speech pathologist will work with a complete laryngectomee to establish new ways of communicating.

There are three main ways of producing voice after a total laryngectomy.

In esophageal speech the patient must learn how to "swallow" air down into the esophagus and create sounds by releasing the swallowed air. This method requires excellent coordination and learning, and produces short bursts of a few syllables of low-volume sound.

Tracheoesophageal speech diverts the inhaled air through an opening in the trachea, made by the surgeon. This air then passes through an implanted artificial voice prosthesis, which is a small tube that makes a sound when air goes through it.

The third method of artificial voice production involves using a handheld electronic device that translates vibrations into sounds. There are several different types of these devices, but all require the use of at least one hand to hold the device to the throat. The choice of which method to use depends on many things including the age and health of the laryngectomee, and whether other parts of the mouth, such as the tongue, have also been removed.

Many patients resume daily activities relatively soon after surgery. They must take special precautions during showering or shaving. Those who wish to take up sports also require special instruction and equipment, especially concerning water sports, as it is dangerous for water to enter the windpipe and lungs through the stoma.

Regular follow-up visits are important after the application of the larynx cancer therapy, since there is an increased risk of developing a new cancer in the mouth, throat, or other regions of the head or neck. Many self-help and support groups are available to help patients meet others who face similar problems.

Risks

Laryngectomy is often successful in curing early stage cancers. However, it inevitably leads to significant lifestyle changes. Laryngectomees must learn how to speak in new ways. They must be constantly concerned with the upkeep of their stoma. Serious infections can occur if water or other foreign material enters the lungs through an unprotected stoma. Also, women who undergo partial laryngectomy or who learn some types of artificial speech will have a deep voice similar to that of a man. For some women this presents psychological challenges.

Normal outcome

Ideally, the removal of the larynx will remove all cancerous material. The person will recover from the operation, make lifestyle adjustments, and return to a normal active life.

Abnormal outcome

Sometimes cancer spreads to surrounding tissues and it is necessary to remove lymph nodes, parts of the tongue, or other cancerous tissues. As with any major operation, post-surgical infection is possible. Infection is of particular concern to laryngectomees who have chosen to have a voice prosthesis implanted, and is one of the major reasons for having to remove the device.

Key terms

Larynx — Also known as the voice box, the larynx is composed of cartilage that contains the apparatus for voice production. This includes the vocal cords and the muscles and ligaments that move the cords.

Lymph nodes — Accumulations of tissue along a lymph channel, which produce cells called lymphocytes that fight infection.

Tracheostomy — A surgical procedure in which an artificial opening is made in the trachea (windpipe) to allow air into the lungs.

laryngectomy /lar·yn·gec·to·my/ (lar″in-jek´tah-me) surgical removal of the larynx.

laryngectomy

[ler′injek′təmē]

Etymology: Gk, larynx + ektomē, excision

surgical removal of the larynx performed to treat cancer of the larynx. Before complete laryngectomy the patient is referred to a speech pathologist to discuss esophageal speech and prostheses. Antibiotics are usually administered to reduce the risk of infection. With the patient under regional or general anesthesia, the trachea is sutured to the skin, as in a tracheostomy, to ensure an adequate airway. In a partial laryngectomy only the vocal cords are removed, and the tracheostomy is closed within several days. If the malignancy is extensive, the entire larynx is removed, along with the hyoid, epiglottis, false chords, true chords, cricoid cartilage, and two or three rings of the trachea; the tracheostomy is permanent; and a laryngectomy tube is left in place. After surgery the patient is observed for bleeding. A humidified oxygen vaporizer may decrease coughing and mucus viscosity. IV fluids are given, and liquid feedings may be given via nasogastric tube. The patient cannot smell, sniff, or blow his or her nose. A Magic Slate and flash cards are useful for communication. Speech loss is permanent after total laryngectomy. Compare neck dissection,radical neck dissection. laryngectomize, v.

laryngectomy [lar″in-jek´to-me]

partial or total removal of the larynx by surgery. It is usually performed as treatment for cancer of the larynx. Depending on the type of surgical procedure, the patient's speech may change in quality or be lost entirely. Speech therapy is thus an important component of the treatment plan. There are three methods of speaking without use of the larynx. Esophageal speech is one method the patient may learn. The patient is taught to trap air in the esophagus. As an alternative to laryngeal voice, air vibrates the upper esophagus, providing a usable sound for speech. The patient modifies this sound into words by moving lips, tongue, and jaw.

An artificial larynx is a battery-operated device that projects sound into the oral cavity when words are formed. Thetracheoesophageal puncture is a newer technique that is now widely used. It consists of a valve being placed in the tracheal stoma to permit air to be diverted into the esophagus and out through the mouth, with placement of a voice prosthesis to allow speech.

Patient Care. Because of the physical and emotional adjustments that patients and their families must make to the surgical procedure and its aftermath, it is especially important that they receive instruction and counseling prior to surgery. They will need help in coping with their fears and anxieties about the patient's ability to communicate after surgery, and they must know that the members of the health care team are available to listen to them uncritically and answer their questions honestly. Patients should be given an explanation about the type of equipment to be used in the immediate postoperative period and the purpose of each procedure. They are assured that a pencil and paper or other means of communicating by writing will be at the bedside at all times after surgery and that they will not be left without some means of summoning help. It is understandable that one of the greatest fears of these patients is that, since they will be unable to cry out or speak, they will be left alone and might suffocate.

There is some justification for a patient's fear of suffocation; this is the major hazard during the immediate postoperative period. Turning, coughing, and deep breathing are important in maintaining a patent airway. Suctioning may be required, and humidification is also important. An extra tracheostomy tube is kept at the bedside in case an emergency arises and for daily changing of the outer tube if the surgeon so chooses. After a variable period of time, the tracheostomy tube may be removed permanently. Feedings usually begin at 1 to 2 weeks.

In preparation for discharge, patients are taught self-care of their laryngectomy. They are warned against aspirating water into the lungs during bathing or showering. Although a dressing is not necessary for covering the tracheal opening in the neck, the patient may wish to conceal it with a small square of cotton material or wear a collar or scarf of porous material to hide the wound. These types of covering are useful in that they act as filters and remove dust and other irritants from the air being inhaled through the stoma.

Printed material about self-care is available from the local Cancer Society. Many communities have a laryngectomee club, which offers much moral support and information that are valuable to patients and families during the period of adjustment. Information regarding these laryngectomee clubs and other aspects of postlaryngectomy rehabilitation can be obtained by writing to the American Speech Language Hearing Association, 10801 Rockville Pike, Department AP, Rockville, MD 20852; telephone (301) 897–5700.

A, Prior to laryngectomy, air flow is through the nose and mouth. B, Surgical removal of the larynx requires that a new opening be made for air passage. The trachea and esophagus are separated. From Polaski and Tatro, 1996.

laryngectomy

(lar´njek´tmē),
n the surgical removal of the larynx, performed to treat cancer of the larynx.

laryngectomy:

partial or total removal of the larynx by surgery.

laryngectomy

Surgical oncology The surgical removal of part or all the larynx for invasive cancer Types Hemilaryngectomy, supraglottic, total. See Hemilaryngectomy, Subtotal laryngectomy, Supraglottic laryngectomy, Total laryngectomy.